FTP7.10 Preoperative C-reactive protein-to-albumin ratio and its ability to predict outcomes of pancreatic cancer resection: a systematic review

Abstract

Abstract Aim To evaluate the ability of c-reactive protein-to-albumin ratio (CAR) in predicting outcomes in patients undergoing pancreatic cancer resection. Methods We conducted a systematic search of multiple electronic information sources and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Survival outcomes and perioperative morbidity were the evaluated outcome parameters. Results Eight observational studies reporting a total number of 1,056 patients undergoing pancreatic cancer resection were identified. The median cut-off value for CAR was 0.05 (range 0.0003- 0.54). Using multivariate analysis, all the included studies demonstrated that a higher CAR value was an independent and significant predictor of poor overall survival in patients undergoing pancreatic cancer resection. The estimated hazard ratio provided by the included studies ranged from 1.4 to 3.6. There was significant heterogeneity among the included studies; for example use of neoadjuvant or adjuvant chemotherapy, pTNM staging, lymph node metastasis, preoperative Ca19-9 and CEA levels, neutrophil-to-lymphocyte ratio, and modified Glasgow prognostic score. Furthermore, important prognostic characteristics such as tumour site and size, pathological T factor, and vascular involvement were poorly reported. Conclusions Preoperative CAR value seems to be an important prognostic score in predicting survival outcomes in patients undergoing pancreatic cancer resection. However, the current evidence does not allow determination of an optimal cut-off value for CAR considering the heterogeneous reporting of cut-off values by the available studies and lack of knowledge of their sensitivity and specificity. Future research is required.